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Intermittent explosive disorder

Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which you react grossly out of proportion to the situation. Road rage, domestic abuse, throwing or breaking objects, or other temper tantrums may be signs of intermittent explosive disorder.

People with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage. They may also injure themselves during an outburst. Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.

If you have intermittent explosive disorder, treatment may involve medications and psychotherapy to help you control your aggressive impulses.

Symptoms
Causes
Risk factors
Complications
Prevention

Explosive eruptions, usually lasting less than 30 minutes, often result in verbal assaults, injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression. In between explosive outbursts, the person may be irritable, impulsive, aggressive or angry.

Aggressive episodes may be preceded or accompanied by:

Irritability

Increased energy

Rage

Racing thoughts

Tingling

Tremors

Palpitations

Chest tightness

Feeling of pressure in the head

Depression, fatigue or relief may occur after the episode.

Related

If you're concerned because you're having repeated emotional outbursts, talk with your primary care doctor or make an appointment with someone who specializes in treating emotional disorders, such as a psychiatrist, psychologist or social worker.

What you can do

These steps can help you make the most of your appointment:

Write down the symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, vitamins, supplements or herbal products that you're taking.

Write down questions to ask your doctor.

Prepare a list of questions to make sure you cover everything that's important to you. For intermittent explosive disorder, some basic questions to ask your doctor include:

Why am I having these angry outbursts?

Do I need any tests? Do these tests require any special preparation?

Is this condition temporary or long lasting?

What treatments are available, and which do you recommend?

Are there any side effects from treatment?

Are there any alternatives to the primary approach that you're suggesting?

I have other health conditions. How can I best manage these conditions together?

Is there a generic alternative to the medicine you're prescribing?

How long does therapy take to work?

Do you have any printed material on this topic? What websites do you recommend?

To determine a diagnosis of intermittent explosive disorder and eliminate other conditions that may be causing your symptoms, expect your doctor to do a:

Physical exam. Your doctor will try to rule out physical problems that could cause your symptoms. Your exam may include lab tests.

Psychological evaluation. A doctor or mental health provider will talk to you about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.

To be diagnosed with intermittent explosive disorder, your doctor will ask about your behavior to see if you meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

DSM criteria include:

Multiple incidents of failure to resist aggressive impulses that resulted in deliberate destruction of property or assault of another person

A degree of aggressiveness during incidents that's completely out of proportion to the event that triggered the behavior

Aggressive episodes that aren't accounted for by another mental disorder and aren't due to the effects of a drug or a medical condition

Other conditions that must be ruled out before making a diagnosis of intermittent explosive disorder include other mental disorders or substance use problems.

There's no one treatment that's best for everyone with intermittent explosive disorder. Treatment generally includes psychotherapy and medication.

Psychotherapy

Individual or group therapy sessions can be helpful. A commonly used type of therapy, cognitive behavioral therapy, helps people with intermittent explosive disorder identify which situations or behaviors may trigger an aggressive response. And, more importantly, this type of therapy teaches people how to manage anger and control inappropriate responses using techniques such as relaxation training, thinking differently about situations (cognitive restructuring) and learning coping skills.

Medication

Different types of drugs may help in the treatment of intermittent explosive disorder. These medications include:

Controlling your anger

If you recognize your own behavior in the description of intermittent explosive disorder, talk with your doctor about treatment options or ask for a referral to a mental health professional. Some techniques that may be part of your treatment include:

Unlearn bad behavior. Coping well with anger is a learned behavior. Cognitive behavioral therapy or anger management will help you recognize what pushes your buttons and how to respond in ways that work for you instead of against you.

Develop a plan. Work with your doctor on developing a plan of action for when you feel yourself getting angry. For example, if think you might lose control, try to remove yourself from that situation. Go for a walk or call a trusted friend to try to calm down.

Avoid alcohol and other substance use. These can increase aggressiveness and the risk of explosive outbursts.

If your loved one won't get help

Unfortunately, many people with intermittent explosive disorder don't seek treatment. If you're involved in a relationship with someone who has intermittent explosive disorder, take steps to protect yourself and your children. The abuse isn't your fault. No one deserves to be abused.

Create an escape plan to stay safe from domestic violence

If you see that a situation is getting worse, and suspect your loved one may be on the verge of an explosive episode, try to safely remove yourself and your children from the scene. However, leaving someone with an explosive temper can be dangerous. Consider taking these steps before an emergency arises:

Call a domestic violence hot line or a women's shelter for advice, either when the abuser isn't home or from a friend's house.

Keep all firearms locked away or hidden. Don't give the abuser the key or combination to the lock.

Pack an emergency bag that includes items you'll need when you leave, such as extra clothes, keys, personal papers, medications and money. Hide it or leave the bag with a friend or neighbor.

Know where you'll go and how you'll get there if you feel threatened, even if it means you have to leave in the middle of the night.

Get help to protect yourself from domestic violence

In an emergency, call 911 or your local emergency number or your local law enforcement agency. These resources also can help:

Your doctor or the emergency room. If you're injured, doctors and nurses can treat and document your injuries and let you know what local resources are available to keep you safe.

National Domestic Violence Hotline: 800-799-SAFE (800-799-7233). This hot line is available for crisis intervention and referrals to resources, such as women's shelters.

A local women's shelter or crisis center. Shelters and crisis centers generally provide 24-hour emergency shelter, as well as advice on legal matters and advocacy and support services.

A counseling or mental health center. Many communities offer counseling and support groups for people in abusive relationships. Be wary of advice to seek couples or marriage counseling. If violence has escalated to the point that you're afraid of your partner, this type of counseling won't be enough. Remember that your safety comes first.

A local court. Your local court can help you get a restraining order that legally orders the abuser to stay away from you or face arrest. Local advocates may be available to help guide you through the process.